Medical Billing Tips - Simplify Payer Enrollment

October 21, 2014 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management

Using CAQH to Simplify Payer Enrollment

Working with payers is not always easy. (Denied claims, long remittance times, and coverage disputes have likely caused more than a few headaches at your practice.) But thanks to an initiative from the Council for Affordable Quality Healthcare (CAQH), provider enrollment with payers is a little simpler than it used to be – giving you less reason to reach for the ibuprofen.

CAQH, a non-profit alliance, has several different initiatives focused on streamlining the business of healthcare.  CAQH strives to be “a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers” in pursuit of higher quality care for patients.

One of CAQH’s programs is the Universal Provider Datasource® (UPD), an all-in-one platform where providers can submit, store, update, and access the information they need to work with payers. (Credentialing, claims processing, and quality assurance are all included in UPD, with credentialing being the primary service.) Payers working with CAQH can use UPD to electronically download participating providers’ information into their systems.

More and more payers are requiring healthcare professionals to register with CAQH to make their jobs easier, and CAQH has made it relatively simple for you to register. Just contact a payer to request its individualized CAQH registration kit, which will enable you to get started on the CAQH website. (You can’t sign up without the payer-specific kit.)

Then follow the online process, which includes a question or two in which you’ll authorize the payer access to your records. Keep in mind that there may be separate UPD questionnaires or request forms needed to confirm your participation in a specific payer network, so ask the payer’s representative about those up from. Once you’re registered, your information will be passed into the UPD automatically.

CAQH also offers EnrollHub™, a secure electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollment tool. EnrollHub serves as a single online enrollment hub for working with your health plans – eliminating the need for you to enroll in EFT and ERA separately with each payer or to process your claim payments by paper check. Twelve health plans are either already using the EFT and ERA Enrollment Tool or are in the implementation process. If you work with any of those twelve (listed here), EnrollHub can help you to get paid faster.

Plus, CAQH asks for minimal information from your practice during the registration process and handles the work of sending your enrollment information to the payers you select. Best of all, it sends payer payments directly into your bank account. To register, click here.

And if you need more help working with payers, consider how utilizing a medical billing service can streamline processes at your practice. For more information, click here.


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